Clinton Surgery Puts Attention On Death Rate

By LAWRENCE K. ALTMAN

Published: September 6, 2004

The hospital where former President Bill Clinton awaits bypass surgery has the highest death rate for the operation in New York State, according to the state's Health Department. While the death rate is quite low -- fewer than 4 percent of all bypass operations -- it is still nearly double the average for hospitals in the state that perform bypasses.

The Clinton family had no comment on the Health Department's statistical profile, which showed that the hospital, Columbia-Presbyterian Center of New York-Presbyterian Hospital, had a 3.93 percent overall death rate for coronary bypass surgery in 2001, the latest year for which data were available. Mr. Clinton, 58, has been a patient at the hospital since Friday.

The figure for the hospital was nearly double the 2.18 percent overall death rate for coronary bypass operations in all 35 hospitals that perform the procedure in the state.

Last night, The Associated Press reported that a person close to Mr. Clinton, who spoke only on the condition of anonymity, said the former president had told him that the surgery would take place this morning.

A spokesman for the hospital, a major teaching center for the Columbia University College of Physicians and Surgeons located in the Washington Heights neighborhood of Manhattan, said no one was available yesterday for comment on the state data.

The state uses several statistical measures and adjusts the overall statistics to account for about 45 risk factors -- like differences in the severity of illness among patients, the state of patients' health before the operation, the skill of the operating team and general postoperative care after the surgery -- to arrive at risk-adjusted death rates for all the hospitals.

Columbia-Presbyterian and Westchester Medical Center were the only two hospitals in the state that had risk-adjusted death rates that were significantly higher than the statewide rate. The rate for Westchester Medical Center, in Valhalla, was 3.27. There was no indication that the Clinton family was aware of the state report when Mr. Clinton checked in on Friday with blockages in a number of coronary arteries.

Indeed, like many people who suddenly learn they have heart disease and need bypass surgery, Mr. Clinton had little chance to study statistics or consult experts on where to go. He simply found himself on a medical-referral track that led from a small hospital near his home in Chappaqua, N.Y., to the Westchester Medical Center, where tests revealed the extent of his problem and cardiologists suggested Columbia-Presbyterian.

Speaking to reporters in Syracuse on Friday, Mrs. Clinton said her husband ''is in excellent hands at one of the great hospitals in the world.'' Columbia-Presbyterian is well-regarded for its teaching, research and patient care, and like many hospitals, it features its reputation in a wide range of advertising and promotional efforts.

For each of the past 14 years, the Health Department has provided a report, which includes statistics on various types of heart surgery, for patients who are considering such surgery and their families. The aim is to help better inform patients in deciding where they want to go for the operation, which is considered major surgery.

The state also provides the data to health care providers to improve the quality of care for heart disease, which is the leading cause of death in this country. State Health Department officials have cited the use of such reports for gradually reducing the death rate from bypass surgery over the years. ''Whether patients recover quickly, experience complications or die following a procedure is in part a result of the kind of medical care they receive,'' the state report said.

The Health Department monitors changes in the annual rates because they often change, as they did for the two hospitals. In 2000, when the overall statewide rate was 2.32 percent, the rates for Columbia-Presbyterian and Westchester Medical Center were within the usual range, at 2.24 and 2.91, respectively.

The two hospitals with the most favorable rates in 2001 were Staten Island University-North and New York Weill Cornell Center in Manhattan. Their risk adjusted rates were 0.34 percent and 0.95 percent, respectively, compared with that of the state.

The state also provides specific death rates for each surgeon performing coronary bypass operations.

Mr. Clinton, his family and the hospital have provided few details about the impending surgery, and have not publicly identified the surgeons who will perform the bypass. The state's death statistics cover bypass patients who die in the hospital during or after surgery. If a patient is discharged from the hospital, a death is reflected in the statistics if it occurs within 30 days of the procedure.

One reason for the two-year delay in providing the figures is that the state has to await information about deaths of patients who were operated on in New York but died elsewhere, said Dr. O. Wayne Isom, the vice chairman of the committee that advises the state on its monitoring program for adult cardiac surgery.

The state does not analyze the cause of the deaths, Dr. Isom, a cardiac surgeon and surgeon in chief at Weill Cornell Center, said in an interview.

Deaths during bypass surgery from complications of anesthesia and other aspects of the operation once were an important risk but now rarely occur, he said.

A major reason for the favorable change is that doctors have used newer drugs and devices to help stabilize a patient's condition before performing coronary bypass surgery, Dr. Isom said.